Shoulder dystocia: Difference between revisions
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==Background== | ==Background== | ||
*Occurs in 0.2 to 3 percent of all births | *Occurs in 0.2 to 3 percent of all births | ||
*Pre-labor | |||
===Risk Factors=== | |||
*Pre-labor | |||
**Previous shoulder dystocia | **Previous shoulder dystocia | ||
**Macrosomia | **Macrosomia | ||
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**Maternal BMI > 30 | **Maternal BMI > 30 | ||
**Induction of labor | **Induction of labor | ||
*Intrapartum | *Intrapartum | ||
**Prolonged first or second stage | **Prolonged first or second stage | ||
**Oxytocin augmentation | **Oxytocin augmentation | ||
Revision as of 04:05, 3 August 2015
Background
- Occurs in 0.2 to 3 percent of all births
Risk Factors
- Pre-labor
- Previous shoulder dystocia
- Macrosomia
- DM
- Maternal BMI > 30
- Induction of labor
- Intrapartum
- Prolonged first or second stage
- Oxytocin augmentation
- Assisted vaginal delivery
Clinical Presentation
A clinical diagnosis. It should be suspected when the fetal head retracts into the perineum (ie, turtle sign) after expulsion due to reverse traction from the shoulders being impacted at the pelvic inlet. The diagnosis is made when the routine practice of gentle, downward traction of the fetal head fails to accomplish delivery of the anterior shoulder.
Differential Diagnosis
- Emergent delivery
- Umbilical cord prolapse
- Breech delivery
- Shoulder dystocia
- Perimortem cesarean delivery
Diagnosis
Treatment
- No method of delivery has been shown to be better or safer
HELPER
- H call for help
- E episiotomy (or episioproctotomy) to increase the anteroposterior diameter of passage
- L Legs flex (McRoberts maneuver)
- P Pressure - rocking suprapubic pressure and Rubin’s maneuver (applying shoulder pressure to the fetus to decreases the bisacromial diameter) - try for 30 seconds
- E Enter the vagina and attempt Wood’s corkscrew maneuver by pushing the most accessible shoulder toward the chest to corkscrew the shoulders through - maintain rocking suprapubic pressure at the same time
- R Remove posterior arm by sweeping it across the chest and bring fetal hand to the chin, grasp and pull out of the birth canal and across the face
- Repeat maneuvers on all fours - move pt to her hands and knees, 82 cases of shoulder dystocia, ~80% delivered without additional maneuvers[1]
Complications
- Transient brachial plexus palsy (3.0 to 16.8 percent)
- Clavicular fracture (1.7 to 9.5 percent)
- Humerus fracture (0.1 to 4.2 percent)
- Permanent brachial plexus palsy (0.5 to 1.6 percent)
- Hypoxic-ischemic encephalopathy (0.3 percent)
- Death (0 to 0.35 percent)
See Also
References
- ↑ Bruner JP et al. All-fours maneuver for reducing shoulder dystocia during labor. J Reprod Med. 1998 May;43(5):439-43.